Chapter 3 The APA Ethics Code and Ethical Decision MakingThe APA.docx

Chapter 3 The APA Ethics Code and Ethical Decision Making
The APA’s Ethics Code provides a set of aspirational principles
and behavioral rules written broadly to apply to psychologists’
varied roles and the diverse contexts in which the science and
practice of psychology are conducted. The five aspirational
principles described in Chapter 2 represent the core values of
the discipline of psychology that guide members in recognizing
in broad terms the moral rightness or wrongness of an act. As an
articulation of the universal moral values intrinsic to the
discipline, the aspirational principles are intended to inspire
right actions but do not specify what those actions might be.
The ethical standards that will be discussed in later chapters of
this book are concerned with specific behaviors that reflect the
application of these moral principles to the work of
psychologists in specific settings and with specific populations.
In their everyday activities, psychologists will find many
instances in which familiarity with and adherence to specific
Ethical Standards provide adequate foundation for ethical
actions. There will also be many instances in which (a) the
means by which to comply with a standard are not readily
apparent, (b) two seemingly competing standards appear equally
appropriate, (c) application of a single standard or set of
standards appears consistent with one aspirational principle but
inconsistent with another, or (d) a judgment is required to
determine whether exemption criteria for a particular standard
are met.
The Ethics Code is not a formula for solving these ethical
challenges. Psychologists are not moral technocrats simply
working their way through a decision tree of ethical rules.
Rather, the Ethics Code provides psychologists with a set of
aspirations and broad general rules of conduct that
psychologists must interpret and apply as a function of the
unique scientific and professional roles and relationships in
which they are embedded. Successful application of the

principles and standards of the Ethics Code involves a
conception of psychologists as active moral agents committed to
the good and just practice and science of psychology. Ethical
decision making thus involves a commitment to applying the
Ethics Code and other legal and professional standards to
construct rather than simply discover solutions to ethical
quandaries (APA, 2012f).
This chapter discusses the ethical attitudes and decision-making
strategies that can help psychologists prepare for, identify, and
resolve ethical challenges as they continuously emerge and
evolve in the dynamic discipline of psychology. An opportunity
to apply these strategies is provided in the cases at the end of
each chapter and the 10 case studies presented in Appendix A.
Ethical Commitment and Virtues
The development of a dynamic set of ethical standards for
psychologists’ work-related conduct requires a personal
commitment and lifelong effort to act ethically; to encourage
ethical behavior by students, supervisees, employees, and
colleagues; and to consult with others concerning ethical
problems.
—APA (2010b, Preamble)
Ethical commitment refers to a strong desire to do what is right
because it is right (Josephson Institute of Ethics, 1999). In
psychology, this commitment reflects a moral disposition and
emotional responsiveness that move psychologists to creatively
apply the APA’s Ethics Code principles and standards to the
unique ethical demands of the scientific or professional context.
The desire to do the right thing has often been associated with
moral virtues or moral character, defined as a disposition to act
and feel in accordance with moral principles, obligations, and
ideals—a disposition that is neither principle bound nor
situation specific (Beauchamp & Childress, 2001; MacIntyre,
1984). Virtues are dispositional habits acquired through social
nurturance and professional education that provide
psychologists with the motivation and skills necessary to apply
the ideals and standards of the profession (see, e.g., Hauerwas,

1981; Jordan & Meara, 1990; May, 1984; National Academy of
Sciences, 1995; Pellegrino, 1995). Fowers (2012) described
virtues as the cognitive, emotional, dispositional, behavioral,
and wisdom aspects of character strength, which motivates and
enables us to act ethically out of an attachment to what is good.
Focal Virtues for Psychology
Virtue ethics can provide psychologists a more personal and
therefore more effective foundation from which to approach
ethical issues, and it helps offset an overreliance on conformity
to rules that may be inconsistent with the aspirational principles
of the discipline (Anderson & Handelsman, 2013; Kitchener &
Anderson, 2011). Many moral dispositions have been proposed
for the virtuous professional (Beauchamp & Childress, 2001;
Keenan, 1995; MacIntyre, 1984; May, 1984). For disciplines
such as psychology, in which codes of conduct dictate the
general parameters but not the context-specific nature of ethical
conduct, conscientiousness, discernment, and prudence are
requisite virtues.
· A conscientious psychologist is motivated to do what is right
because it is right, diligently tries to determine what is right,
makes reasonable attempts to do the right thing, and is
committed to lifelong professional growth.
· A discerning psychologist brings contextually and relationally
sensitive insight, good judgment, and appropriately detached
understanding to determine what is right.
· A prudent psychologist applies practical wisdom to ethical
challenges, leading to right solutions that can be realized given
the nature of the problem and the individuals involved.
The virtues considered most salient by members of a profession
will vary with differences in role responsibilities. The
asymmetrical power relationship and the client’s/patient’s
vulnerability in the provision of mental health services requires
virtues of benevolence, care, empathy, emotional self-restraint
and monitoring, and compassion (Ivey, 2014). Prudence,
discretion, and trustworthiness have been considered salient in
scientific decision making. Scientists who willingly and

consistently report procedures and findings accurately are
enacting the virtue of honesty (Fowers, 2012). Fidelity,
integrity, and wisdom are moral characteristics frequently
associated with teaching and consultation. The Standards for
Forensic Psychology (APA, 2013e) encourages forensic
practitioners to act with reasonable diligence and promptness in
managing their workloads so they can provide agreed upon and
reasonably anticipated services across all work activities. The
virtue of self-care enables psychologists to maintain appropriate
competencies under stressful work conditions (see the Hot
Topic “The Ethical Component of Self-Care” at the end of this
chapter).
Openness to Others
“Openness to the other” has been identified as a core virtue for
the practice of multiculturalism (Fowers & Davidov, 2006).
Openness is characterized by a personal and professional
commitment to applying a multicultural lens to our work
motivated by a genuine interest in understanding others rather
than reacting to a new wave of multicultural “shoulds”
(Gallardo, Johnson, Parham, & Carter, 2009). It reflects a
strong desire to understand how culture is relevant to the
identification and resolution of ethical challenges in research
and practice, to explore cultural differences, to respond to fluid
definitions of group characteristics, to recognize the realities of
institutional racism and other forms of discrimination on
personal identity and life opportunities, and to creatively apply
the profession’s ethical principles and standards to each cultural
context (Aronson, 2006; Fisher, 2015; Fowers & Davidov, 2006;
Hamilton & Mahalik, 2009; Neumark, 2009; Riggle, Rostosky,
& Horne, 2010; Sue & Sue, 2003; Trimble, 2009; Trimble &
Fisher, 2006).
Openness may also be a core virtue for practicing in the primary
care interprofessional organizations created by the Affordable
Care Act, where the psychologists’ role extends beyond
providing patient services to include making contributions to
integrated teams of health care professionals. Nash et al. (2013)

have proposed a “primary care ethic” that reflects a guiding
philosophy or set of values characterized by openness,
appreciation, and willingness to engage as a psychologist in the
interprofessional primary care environment. It reflects (a) a
respect and appreciation for contributions by professionals from
other disciplines; (b) a desire to integrate disciplinary
perspectives; (c) a valuing of collaborative relationships and a
willingness to cultivate and maintain them; and (d) a
willingness to initiate clear, open, and constructive
interprofessional communication.
Can Virtues Be Taught?
No course could automatically close the gap between knowing
what is right and doing it.
—Pellegrino (1989, p. 492)
Some have argued that psychology professors cannot change
graduate students’ moral character through classroom teaching
and therefore ethics education should focus on understanding
the Ethics Code rather than instilling moral dispositions to right
action. Without question, however, senior members of the
discipline, through teaching and through their own examples,
can enhance the ability of students and young professionals to
understand the centrality of ethical commitment to ethical
practice. At the same time, the development of professional
moral character is not to simply know about virtue but to
become good (Scott, 2003). Beyond the intellectual virtues
transmitted in the classroom and modeled through mentoring
and supervision, excellence of character can be acquired
through habitual practice (Begley, 2006). One such habit for the
virtuous graduate student and seasoned psychologist is a
commitment to lifelong learning and practice in the continued
development of moral excellence.
Some moral dispositions can be understood as derivative of
their corresponding principles (Beauchamp & Childress, 2001).
Drawing on the five APA General Principles, Table 3.1 lists
corresponding virtues.
Ethical Awareness and Moral Principles

In the process of making decisions regarding their professional
behavior, psychologists must consider this Ethics Code, in
addition to applicable laws and psychology board regulations.
—APA (2010b, Introduction)
Lack of awareness or misunderstanding of an ethical standard is
not itself a defense to a charge of unethical conduct.
—APA (2010b, Introduction)
Ethical commitment is just the first step in effective ethical
decision making. Good intentions are insufficient if
psychologists fail to identify the ethical situations to which they
should be applied. Psychologists found to have violated Ethical
Standards or licensure regulations have too often harmed others
or damaged their own careers or the careers of others because of
ethical ignorance. Conscientious psychologists understand that
identification of situations requiring ethical attention depends
on familiarity and understanding of the APA Ethics Code,
relevant scientific and professional guidelines, laws and
regulations applicable to their specific work-related activities,
and an awareness of relational obligations embedded within
each context.
Moral Principles and Ethical Awareness
To identify a situation as warranting ethical consideration,
psychologists must be aware of the moral values of the
discipline. Although the Ethics Code’s General Principles are
not exhaustive, they do identify the major moral ideals of
psychology as a field. Familiarity with the General Principles,
however, is not sufficient for good ethical decision making.
Psychologists also need the knowledge, motivation, and coping
skills to detect when situations call for consideration of these
principles and attempt to address these issues when and if
possible before they arise (Crowley & Gottlieb, 2012; Tjeltveit
& Gottlieb, 2010; see also the Hot Topic “The Ethical
Component of Self-Care” at the end of this chapter). Table
3.1 identifies types of ethical awareness corresponding to each
General Principle.

Ethical Awareness and Ethical Theories
Ethical theories provide a moral framework to reflect on
conflicting obligations. Unfortunately, ethical theories tend to
emphasize one idea as the foundation for moral decision
making, and illustrative problems are often reduced to that one
idea. Given the complexity of moral reality, these frameworks
are probably not mutually exclusive in their claims to moral
truth (Steinbock, Arras, & London, 2003). However, awareness
of the moral frameworks that might help address an ethical
concern can also help clarify the values and available ethical
choices (Beauchamp & Childress, 2001; Fisher, 1999;
Kitchener, 1984).
Deception Research: A Case Example for the Application of
Different Ethical Theories
Since Stanley Milgram (1963) published his well-known
obedience experiments, the use of deception has become
normative practice in some fields of psychological research and
a frequent source of ethical debate (Baumrind, 1964, 1985;
Fisher & Fyrberg, 1994). Researchers using deceptive
techniques intentionally withhold information or misinform
participants about the purpose of the study, the methodology, or
roles of research confederates (Sieber, 1982). Deception is still
widely practiced within experimental social psychology and in
sexual health behavior and health care research (Kirschner et
al., 2010; Miller, Gluck, & Wendler, 2008; Wong et al., 2012).
By its very nature, the use of deception in research creates what
Fisher (2005a) has termed the consent paradox: obtaining
‘informed consent’ under conditions in which participants are
not truly informed.
On the one hand, intentionally deceiving participants about the
nature and purpose of a study conflicts with Principle C:
Integrity and Principle E: Respect for People’s Rights and
Dignity and with enforceable standards requiring
psychologists to obtain fully informed consent of research
participants prior to study initiation (Standards 3.10, Informed
Consent; 8.02, Informed Consent to Research; 9.03, Informed

Consent in Assessments; 10.01, Informed Consent to Therapy).
On the other hand, the methodological rationale for the use of
deception is that some psychological phenomena cannot be
adequately understood if research participants are aware of the
purpose of the study. Thus by approximating the naturalistic
contexts in which everyday behaviors take place, deception
research can reflect Principle A: Beneficence and
Nonmaleficence and Principle B: Fidelity and Responsibility by
enhancing the ability of psychologists to generate scientifically
and socially useful knowledge that might not otherwise be
obtained. For example, deception has been used to study the
phenomenon of “bystander apathy effect,” the tendency for
people in the presence of others to observe but not help a person
who is a victim of an attack, medical emergency, or other
dangerous condition (Latane & Darley, 1970). In such
experiments, false emergency situations are staged without the
knowledge of the research participants, whose reactions to the
“emergency” are recorded and analyzed.
Standard 8.07, Deception in Research (as well as federal
regulations governing participant protections) permits deception
under limited conditions. However, its use remains ethically
controversial. Below we present a case example of a deception
study with discussion of how different ethical theories might
lead to different conclusions about the moral acceptability of
deceptive research. Readers should refer to Chapter 11 for a
more in-depth discussion of Standard 8.07, Deception in
Research.
Case Example
The Gaffe Study (Gonzales, Pederson, Manning, & Wetter,
1990)
This experiment was conducted to examine whether
undergraduate males and females differ in their explanations for
an embarrassing incident and whether the severity of their
mistake would influence their explanations. Undergraduate
students were “invited” to help researchers develop a video for
a future study on how people form impressions. Each student

participated in a taped discussion with another student in which
they either were interviewed or were the interviewer. They were
not told the true purpose of the study or that the other “student”
was actually a confederate of the research team. Participants
were then told to place their belongings on a table. As they did
so, the experimenter pulled a hidden string attached to a
strategically placed cup of colored water, which spilled onto
what appeared to be the confederate’s bag. For half the
participants, only papers were in the tote bag (low-severity
incident) while for the other half an expensive camera was in
the tote bag (high-severity incident). Immediately after the cup
spilled, the confederate exclaimed, “Oh no, my stuff!” followed
by “What happened?” The experimenter had turned on the video
so that participants’ nonverbal responses (e.g., hand to face,
head shaking), instrumental behaviors (e.g., attempts to empty
the bag), and verbal responses (e.g., “I’m sorry” or “I didn’t do
it”) could be analyzed. See Fisher and Fyrberg (1994) to learn
how introductory students evaluated the ethics of this study.
Ethical Theories
Deontology or Kantian Ethics
Deontology has been described as “absolutist,” “universal,” and
“impersonal” (Kant, 1785/1959). It prioritizes absolute
obligations over consequences. In this moral framework, ethical
decision making is the rational act of applying universal
principles to all situations irrespective of specific relationships,
contexts, or consequences. This approach reflects Immanuel
Kant’s conviction that ethical decisions cannot vary or be
influenced by special circumstances or relationships. Rather,
Kant stipulated that an ethical decision is only morally justified
if a rational person believes the act resulting from the decision
should be universally followed in all situations. This is called
the categorical imperative. For Kant, respect for the worth of all
persons was one such universal principle. A course of action
that results in a person being used simply as a means for others’
gains would be ethically unacceptable.
With respect to deception in research, from a deontological

perspective, since we would not believe it moral to intentionally
deceive individuals across a variety of other contexts, neither
the potential benefits to society nor the effectiveness of
participant debriefing (informing participants about the true
nature of the study after their participation is completed) for a
particular deception study can morally justify intentionally
deceiving persons about the purpose or nature of the study.
Further, from a Kantian perspective, deception in research is not
ethically permissible, since intentionally disguising the nature
of the study for the goals of research violates the moral
obligation to respect each participant’s intrinsic worth by
undermining that individual’s right to make rational and
autonomous informed consent decisions regarding participation
(Fisher & Fyrberg, 1994).
Utilitarianism or Consequentialism
Utilitarian theory prioritizes the consequences (or utility) of an
act over the application of universal principles (Mill,
1861/1957). From this perspective, an ethical decision is
situation specific and must be governed by a risk–benefit
calculus that determines which act will produce the greatest
possible balance of good over bad consequences. An “act
utilitarian” makes an ethical decision by evaluating the
consequences of an act for a given situation. A “rule utilitarian”
makes an ethical decision by evaluating whether following a
general rule in all similar situations would create the greater
good. Like deontology, utilitarianism is impersonal: It does not
take into account interpersonal and relational features of ethical
responsibility. From this perspective, psychologists’ obligations
to those with whom they work can be superseded by an action
that would produce a greater good for others.
A psychologist adhering to act utilitarianism might decide that
the potential knowledge about social behavior during an
embarrassing situation generated by this deception study could
produce benefits for many members of society, thereby
justifying the minimal risk of harm that the embarrassment
might cause and the violation of autonomy rights based on the

absence of true informed consent for only a few research
participants. A rule utilitarian might decide against the use
of deception in all research studies because the unknown
benefits to society do not outweigh the potential harm to the
discipline of psychology if society began to see it as an
untrustworthy science.
Communitarianism
Communitarian theory assumes that right actions derive from
community values, goals, traditions, and cooperative virtues. It
considers the common good, community values and goals, and
cooperative virtues as fundamental to ethical decision making
(MacIntyre, 1989; Melchert, 2015; Walzer, 1983).
Communitarianism is often contrasted with liberal
individualism, an ethical theory that privileges the individual
over the group and identifies individual autonomy, privacy,
property, free speech, and freedom of religion as the
cornerstones of a civil society, thus elevating individual over
group rights (Beauchamp & Childress, 2001; Dworkin, 1977).
Although all forms of communitarianism support ethical
decisions that improve the health and welfare of members of the
community, some forms value group welfare over individual
rights and reject the deontological categorical imperative that
ethical decisions have universal application across different
communities.
Whereas utilitarianism asks whether a policy will produce the
greatest good for all individuals in society, communitarianism
asks whether a policy will promote the kind of community we
want to live in (Steinbock et al., 2003). For example, from a
communitarian perspective, the competent practice of
psychology cannot be defined simply in terms of individual
interpretations of ethical standards but rather must be
consistently evaluated and affirmed through interdependent and
communal dialogue and support among members of the field
(Johnson, Barnett, Elman, Forrest, & Kaslow, 2013).
The challenge to a communitarian perspective is the question of
which community values should be represented in ethical

decision making. Drawing on the principle of justice, Fisher and
her colleagues have argued that the values of a majority may not
reflect the needs or values of a more vulnerable minority within
a community. For this reason, scientific, intervention, or policy
decisions made in response to majority values may result in or
perpetuate health disparities and other inequities suffered by
marginal groups (Fisher, 1999, 2011; Fisher et al., 2002; Fisher
& Wallace, 2000). For example, sensitivity to “who is the
community” is particularly important when psychologists are
consulting with community “representatives” in the design and
evaluation of social or educational programs. Restricting
consultation to community leaders and program administrators
may result in programs that fail to adequately serve the
members most in need.
Research psychologists who believe deception research is
ethically justified can be conceived as members of a scientific
community of shared values that has traditionally assumed (a)
the pursuit of knowledge is a universal good, (b) the results of
deception research are intrinsically valuable, and (c)
consideration for the practical consequences of research will
inhibit scientific progress (Fisher, 1999; Sarason, 1984; Scarr,
1988). The historical salience of these shared values may be
implicitly reflected, at least in part, in the acceptance of
deception research in the APA Ethics Code (Standard 8.07,
Deception in Research) and in current federal regulations
(Department of Health and Human Services [DHHS], 2009).
However, little is known about the extent to which the
“community of research participants” shares the scientific
community’s valuing of deception methods. The participant
community may instead place greater value on their right to
determine whether they will be exposed to specific research
risks and benefits and on society’s need to perceive scientists as
members of a trustworthy profession.
Relational Ethics
Relational ethics, originating out of feminist ethics or an ethics
of care, sees a commitment to act on behalf of persons with

whom one has a significant relationship as central to ethical
decision making. This moral theory rejects the primacy of
universal values of deontology and the cost–benefit calculus of
utilitarianism in favor of relationally specific obligations
(Baier, 1985; Brabeck, 2000; Fisher, 1999, 2000, 2004). It also
rejects communitarianism’s emphasis on group norms and
instead stresses the importance of the uniqueness of individuals
embedded in relationships. Relational ethics focuses our
attention on power imbalances and supports efforts to promote
equality of power and opportunity for women and other
marginalized groups (Brabeck & Brabeck, 2012; Sechzer &
Rabinowitz, 2008). It underscores the value of understanding
the point of view, needs, and expectations of clients/patients,
research participants, and others as a means of enhancing
psychologists’ own moral development and ethical decision
making (Fisher, 2000; Noddings, 1984).
In relational ethics, responsiveness to research participants and
psychologists’ awareness of their own boundaries,
competencies, and obligations are the foundation of ethics-in-
science decision-making (Fisher, 1999, 2002a, 2004, 2011).
From a relational perspective, in the absence of dialogue with
prospective participants, the psychologists designing the
“Gaffe” study, by virtue of their training and institutional
positions, may have overestimated the scientific validity and
value of the study and underestimated undergraduates’ stress,
discomfort, and sense of disempowerment during the study and
following debriefing (Fisher & Fyrberg, 1994). Thus, relational
ethics would view this study as a violation of investigators’
obligations of interpersonal trust to participants and as
reinforcing power inequities by permitting faculty members to
deprive undergraduates of information that might affect their
decision to participate.
Ethical Absolutism, Ethical Relativism, and Ethical
Contextualism
Psychologists with high levels of ethical commitment and
awareness are often stymied by moral complexities that surface

when individuals or cultural communities with whom they work
hold values that are or appear to be distinctly different from the
Ethics Code aspirational principles, contrary to evidence-based
“right” clinical outcomes, or inconsistent with federal
regulations and professional guidelines for protecting the rights
and welfare of research participants. Such dilemmas can be
framed in three different ways.
The first, termed “ethical absolutism,” adopts the universal
perspective of the deontic position and rejects the influence of
culture on the identification and resolution of ethical problems
in a manner that can lead to a one-size-fits-all form of ethical
problem solving. However, psychologists who adopt an
absolutist stance misconceive the discipline of psychology as an
impartial helping or scientific profession whose values and
techniques are universally related to the essential humanity of
those with whom we work (Fisher, 1999; Koenig & Richeson,
2010). For example, drawing on Principle C, Integrity, a
psychologist who has learned that a child client has a genetic
marker for a serious adult onset disorder may believe it is his
ethical duty to share this information with the child, without
considering other moral positions, including the child’s right to
have one’s future options kept open until one is old enough to
make one’s own life choices (Millum, 2014).
In sharp contrast, “ethical relativism,” often associated with
some forms of utilitarianism and communitarianism, denies the
existence of universal or common moral values characterizing
the whole of human relationships, proposing instead that how
ethical problems are identified and resolved is unique to each
particular culture or community. This can result in confusing
what “is” for what “ought” to be (Melchert, 2015). For example,
this stance runs the risk of condoning client or organizational
behaviors, beliefs, and attitudes that reflect systemic cultural
injustices or cultural values such as racism, heterosexism, or
misogyny that are iatrogenic to a client’s mental health or the
well-being of employees or those whom organizations serve
(Cassidy, 2013; Fisher, 2014; Knapp & VandeCreek, 2007).

Ethical contextualism, variously known as cross-cultural ethics
or moral realism, blends the two approaches and assumes that
moral principles such as beneficence, integrity, social justice,
and respect for people’s rights and dignity are or should be
universally valued across diverse contexts and cultures, but the
expression of an ethical problem and the right actions to resolve
it can be unique to the cultural context (Fisher, 1999, 2000,
2014; Korchin, 1980; Macklin, 1999; Melchert, 2015). This
position is reflected in the Universal Declaration of Ethical
Principles for Psychologists (International Union of
Psychological Science, 2008), which includes an articulation of
ethical contextualism in its recognition that these value
principles may be expressed in different ways in different
communities and cultures and that respect for different customs
and beliefs should be limited only when they seriously
contravene “the dignity of persons or peoples or causes serious
harm to their well-being.” Consistent with the relational or
feminist ethics framework, psychologists taking a contextual
stance are motivated to understand how ethical values may be
differentially expressed across different cultural contexts and to
identify when group acceptance of a norm is inconsistent with a
basic universal morality.
Case Example
Working With a Client With Racist Attitudes and Behaviors
Psychotherapists may wrestle with ethical principles guiding
treatment of clients/patients with impulse control or cognitive
or emotional disorders whose symptomology includes
expressions of racist attitudes and behaviors. Consider the case
of a client who has been suspended from work for continued
harassment of and threats against his Hispanic coworkers.
Psychologists applying an ethical absolutist position might jump
to the conclusion that since racism and intolerance are
universally morally reprehensible, the client has no regard for
right and wrong or the feelings of others and thus is suffering
not only from possible impulse control disorders but also from
the more character-based antisocial or paranoid personality

disorder.
By contrast, those holding a relativist position might decide that
the best approach would be to treat the mental health problem as
distinct from the client’s prejudicial attitudes because of their
belief that psychologists should be accepting of their clients’
socially constructed values.
Approaching this dilemma from an ethical contextual
perspective, psychologists would base their treatment plan on
the assumption that, given intolerant beliefs driving the client’s
behavior are inconsistent with basic moral values, the crucial
task for the psychologist is to understand the meaning and
function of the racist attitudes and behaviors as they relate to
the client’s mental health problems and address both the racism
and mental health conditions during treatment.
Ethical Competence
Too often, psychologists approach ethics as an afterthought to
assessment or treatment plans, research designs, course
preparation, or groundwork for forensic or consulting activities.
Ethical planning based on familiarity with ethical standards,
professional guidelines, state and federal laws, and
organizational and institutional policies should be seen as
integral rather than tangential to psychologists’ work.
Ethical Planning
Ethical commitment and well-informed ethical planning will
reduce but not eliminate ethical challenges that emerge during
the course of psychologists’ work. Ideally, ethical competence
should be “preventive.” A working understanding of ethical
theories, Ethics Code principles and standards, scientific and
professional guidelines, laws, and organizational policies
should help psychologists anticipate situations that require
ethical planning before a problem occurs.
Need to Know: “Why Good Students Go Bad”
Burkholder & Burkholder (2014) identified four ethical pitfalls
that often lead students to commit ethical violations:
· Beliefs that the Ethics Code is optional or only applies to
“bad” people

· Personal characteristics, such as mental health and substance
abuse disorders, that distract from a focus on learning how to
integrate ethics into professional activities
· Poor advisement or supervision or misguidance, leading to
deficient preparation and training
· Overenthusiasm, pressure to achieve high grades, or rushing to
complete training requirements that leads to a blurring of
appropriate boundaries, taking inadequate steps to protect
confidentiality, or taking other ethical shortcuts in science or
practice
Need to Know: Ethical Competence and Ethical Planning
Obtaining the competencies necessary to recognize when a
situation requires ethical decision making is a daunting task for
graduate students, early career professionals, and seasoned
professionals (Moffett, Becker, & Patton, 2014). To limit
mistakes that can be made when facing unexpected ethical
challenges, whenever psychologists begin new professional or
scientific work, they should do the following:
· Evaluate their role responsibilities and ensure they have the
competencies required to fulfill these roles
· Identify the potential psychological, social, or legal
vulnerabilities of those with whom they will work
· Become familiar with commonly established ethical
procedures for the type of activities in which they will be
engaged, the populations with whom they will work, and the
work setting
· Develop a plan to readily draw on the ethical standards,
professional guidelines, organizational policies, and laws that
should guide their decision making if unanticipated ethical
situations arise and identify colleagues who can provide
consultation
Competence and Ethical Decision Making
Ethical competence is also necessary to identify unanticipated
situations that require ethical decision making. Ethical problems
often arise when two or more principles or standards appear to
be in conflict, when unexpected events occur, or in response to

unforeseen reactions of those with whom a psychologist works.
There is no ethical menu from which the right ethical actions
can simply be selected. Many ethical challenges are unique in
time, place, and persons involved. The very process of
generating and evaluating alternative courses of action helps
place in vivid relief the moral principles underlying such
conflicts and stimulates creative strategies that may resolve or
eliminate them.
Ethical decisions are neither singular nor static. They involve a
series of steps, each of which will be determined by the
consequences of previous steps. Evaluation of alternative
ethical solutions should take a narrative approach that
sequentially considers the potential risks and benefits of each
action. Understanding of relevant laws and regulations as well
as the nature of institutions, companies, or organizations in
which the activities will take place is similarly essential for
adequate evaluation of the reactions and restraints imposed by
the specific ethical context.
Ethical Standards
Familiarity with the rules of conduct set forth in the Ethical
Standards enables psychologists to take preventive measures to
avoid the harms, injustices, and violations of individual rights
that often lead to ethical complaints. For example,
psychologists familiar with the standards on confidentiality and
disclosure discussed in Chapter 7 will take steps in advance to
(a) develop appropriate procedures to protect the confidentiality
of information obtained during their work-related activities; (b)
appropriately inform research participants, clients/patients,
organizational clients, and others in advance about the extent
and limitations of confidentiality; and (c) develop specific plans
and lists of appropriate professionals, agencies, and institutions
to be used if disclosure of confidential information becomes
necessary.
Guidelines
Good ethical planning also involves familiarity with guidelines
for responsible practice and science. The APA and other

professional and scientific organizations publish guidelines for
responsible practice appropriate to particular psychological
activities. Guidelines, unlike ethical standards, are essentially
aspirational and unenforceable. As a result, compared with the
enforceable Ethics Code standards, guidelines can include
recommendations for and examples of responsible conduct with
greater specificity to role, activity, and context. For example,
Standard 2.01, Boundaries of Competence, requires
psychologists to limit their services to populations and areas
within their boundaries of competence, but as a general standard
it does not specify what such competencies are in different work
contexts. By contrast, guidelines such as those for multicultural
education, training, research, practice, and organizational
change (APA, 2003) describe the specific areas of training,
education, or supervision that psychologists must have to
perform their jobs competently. The Guidelines for the
Evaluation of Dementia and Evaluation of Age-Related
Cognitive Change (APA, 2012d) provide a list of necessary
competencies, including memory changes associated with
normative aging and the broad range of medical,
pharmacological, and mental health disorders (e.g., depression)
that can influence cognition in older adults. The crafters of
guidelines developed by APA constituencies usually attempt to
ensure that their recommendations are consistent with the most
current APA Ethics Code. However, readers should be alert to
instances in which the 2010 Ethics Code renders some guideline
recommendations adopted prior to 2010 obsolete. Specific
Guidelines are discussed throughout this book where their
relevance to ethical standards can be applied. Continuously
updated links to APA guidelines are provided
at http://study.sagepub.com/fisher4e.
Laws, Regulations, and Policies
Another important element of information gathering is
identifying and understanding applicable laws, government
regulations, and institutional and organizational policies that
may dictate or limit specific courses of action necessary to

resolve an ethical problem. There are state and federal laws and
organizational policies governing patient privacy, mandated
reporting for child abuse and neglect and elder abuse, research
with humans and animals, conduct among military enlistees and
officers, employment discrimination, conflicts of interest,
billing, and treatment. For example, practicing psychologists
need to be familiar with rules and procedures under the Health
Insurance Portability and Accountability Act (HIPAA). Those
working in schools must understand privacy rights protections
under the Family Education Rights and Privacy Act (FERPA).
Psychologists involved in forensically relevant activities must
also be familiar with continuing evaluation of rules of evidence
governing expert testimony, and research psychologists need to
know the Department of Health and Human Services Part 46
Protection of Human Subjects. The relevance of these laws to
the science and practice of psychology is discussed throughout
this volume.
As discussed in Chapter 2, only a handful of Ethical Standards
require psychologists to adhere to laws or institutional rules.
However, choosing an ethical path that violates law,
institutional rules, or company policy can have serious
consequences for psychologists and others. Laws and policies
should not dictate ethics, but familiarity with legal and
organizational rules is essential for informed ethical decision
making. When conflicts between ethics and law arise,
psychologists consider the consequences of the decision for
stakeholders, use practical wisdom to anticipate and take
preventive actions for complications that can arise, and draw on
professional virtues to help identify the moral principles most
salient for meeting professional role obligations (Knapp,
Gottlieb, Berman, & Handelsman, 2007).
Stakeholders
Ethical decision making requires sensitivity to and compassion
for the views of the affected individuals. Discussions with
stakeholders can clarify the multifaceted nature of an ethical
problem, illuminate ethical principles that are in jeopardy of

being violated or ignored, and alert psychologists to potential
unintended consequences of specific action choices. In research,
this means enhancing external validity and the generalizability
of findings by understanding the realities of participants’ lives.
To this end, psychologists draw on the perspectives of
prospective participants to ensure that the research design and
procedures reflect their values and merit their trust.
Psychologists also consult with other community stakeholders
to ensure reasonable steps are taken to avoid community harm
that may arise following dissemination of research results
(Fisher, 1999, 2004, 2015).
In assessment, attention to stakeholder perspectives requires
consideration of how examinees’ understanding of the purpose
of a test and their trust in the integrity of the testing process
may facilitate or hinder test validity. It can also include
considering how the way in which a client’s assessment report
is written may affect family members or other third parties. In
therapy, stakeholder sensitivity entails attending to
clients’/patients’ responses to treatment and modifying
approaches based on such feedback rather than simply
categorizing failure to respond as a form of resistance or other
weakness on the part of the client/patient. Sensitivity also
requires understanding that family caretakers of children or
mentally impaired adults and other professionals providing
services in schools, organizations, or integrated health care
systems can be affected by or have an effect on treatment
outcomes.
By taking steps to understand the concerns, values, and
perceptions of clients/patients, research participants, family
members, organizational clients, students, IRBs or corporate
compliance officers, and others with whom they work,
psychologists can avoid making decisions that would be
ineffective or harmful (Fisher, 1999, 2000).
Steps in Ethical Decision Making
A number of psychologists have proposed excellent ethical
decision-making models to guide the responsible conduct of

psychological science and practice (e.g., Barnett, Zimmerman,
& Walfish, 2014; Canter et al., 1994; Handelsman et al., 2005;
Kitchener & Anderson, 2011; Koocher & Keith-Spiegel, 2008;
Newman, Gray, & Fuqua, 1996; Rest, 1983; Staal & King,
2000). A six-step model is proposed that draws on these models
and the importance of ethical commitment, awareness, and
competence:
· Step 1: Through a sustained professional commitment to doing
what is right, develop the skills to identify when a situation
raises ethical issues. This commitment includes (a) continuous
reflection on the personal versus professional values and
potential conflicts of interest influencing reactions to ethical
dilemmas and (b) ongoing implementation of appropriate self-
care strategies to guard against the influence of occupational
stress.
· Step 2: Consider the relevant APA Ethics Code General
Principles and Ethical Standards and scientific and professional
guidelines as well as organizational policies.
· Step 3: Determine whether there are local, state, and federal
laws specific to the ethical situation. Identify also the
procedures required to be in compliance with these laws and the
consequences of legal action for the welfare of individuals with
whom the psychologist works and relevant third parties.
· Step 4: Make efforts to understand the perspective of different
stakeholders who will be affected by and who will affect the
outcome of the decision. These efforts should help illuminate
aspects of the dilemma that are related to power, privilege, and
sociopolitical oppression.
· Step 5: Apply Steps 1 to 4 to generate ethical alternatives.
Assess the competencies required to implement each alternative
and consult with colleagues if necessary. Consider how
different ethical theories might prioritize each alternative.
Select the alternative that best fulfills one’s obligations under
the Ethics Code and has the greatest likelihood of protecting the
rights and welfare of those who will be affected.
· Step 6: Monitor and evaluate the effectiveness of the course of

action. Modify and continue to evaluate the ethical plan if
feasible and necessary.
The cases at the end of each chapter and the 10 case studies
in Appendix A provide readers with the opportunity to
creatively apply the ethical decision-making model described
above and the knowledge they gain in reading chapters
throughout this book to ethical challenges across a broad range
of psychological work. The next section provides an example of
how the six ethical decision-making steps can be applied to an
ethical dilemma.
Step 1: Ethical Commitment.
Dr. Ames is committed to doing the right thing. She thinks of
herself as honest, judicious, respectful, and compassionate. She
struggles with her desire to maintain James’ confidentiality
about his HIV status and her concern about the health risks to
Angela and her pregnancy. She recognizes that as a new mother
herself, she places a high value on the importance of parental
responsibility for an infant’s health and welfare, and her new
parental status is influencing her reaction to Angela’s
disclosure. Since her return from a maternity leave, she has
been diligent in instituting self-care strategies to address the
dual stressors of work and new parenthood.
Case Example
An Example of Ethical Decision Making
Dr. Ames conducts individual and group therapy for young
adults with dual diagnosis (substance dependence and anxiety
disorders) whom she sees in her private practice. Although Dr.
Ames was careful not to enter into the group those of her
patients who were friends, partners, or relatives, she has
recently learned that two group members (James and Angela)
have started to date one another. In her next individual therapy
session, Angela excitedly tells Dr. Ames that she is pregnant
and is planning to move in with James, the father of her baby.
When asked if she has seen a doctor, Angela replies that she
does not have health insurance and has nothing to worry about
since neither she nor James has any diseases. Dr. Ames knows

from previous individual sessions with James that he is HIV
positive. She asks Angela’s permission to speak with James
about their new situation, and Angela agrees. During his next
session, James tells Dr. Ames that he does not plan to tell
Angela that he is HIV positive because she would leave him. He
also angrily reminds Dr. Ames that she is “sworn to secrecy”
because she promised that everything he told her, except child
abuse or hurting someone, would be confidential.
Step 2: Relevant ethical principles, standards, guidelines, and
organizational policies.
Dr. Ames reviews the Ethics Code standards. She realizes that
because two of her group therapy patients have unexpectedly
entered into a romantic relationship discussed only in their
individual sessions that she is confronting an unforeseen
potentially harmful multiple relationship (Standard 3.05b,
Multiple Relationships). She realizes that her concerns
regarding the health risks to Angela and her baby and her
conflict over maintaining James’ confidentiality can potentially
compromise her objectivity and effectiveness in performing her
job. According to Standard 3.05b, she must take reasonable
steps to resolve the problem with due regard for the best
interests of all the affected persons.
Dr. Ames also recognizes that while it is important to protect
James’ confidentiality (Standard 4.01, Maintaining
Confidentiality), the Ethics Code permits her to disclose
confidential information to protect others from harm (Standard
4.05, Disclosures). She had thought that her informed consent
procedure was consistent with ethical standards, since she did
inform James and all her individual and group clients/patients
of her legal obligation to report child abuse and the possibility
that disclosure could also occur to protect others from harm
(Standard 4.02, Discussing the Limits of Confidentiality).
However, although she was prepared to address issues of group
members fraternizing outside of group, she did not anticipate
that this type of situation would arise, and she is unsure about
the answers to the following questions. Should James’ decision

to intentionally keep his HIV status secret and to continue to
have unprotected sex with Angela be considered “harm” to
another person? Did the consent language adequately inform Dr.
Ames’ clients/patients that the risk of transmitting HIV would
meet the criteria for disclosure (Standards 10.01, Informed
Consent to Therapy; 10.03, Group Therapy)?
Dr. Ames also reviews the Ethics Code’s aspirational principles.
She recognizes that she has a fiduciary responsibility to both
James and Angela that rests on establishing relationships of
trust (Principle B: Fidelity and Responsibility) and worries that
the therapeutic alliance with James may be jeopardized if she
discloses his HIV status to Angela and that her therapeutic
alliance with Angela may be compromised if she is perceived to
be colluding with James in a secret that could be harmful to the
health of Angela and her baby (Principle A: Beneficence and
Nonmaleficence, Principle C: Integrity, and Principle E:
Respect for People’s Rights and Dignity).
Step 3: Federal, state, and civil law.
Dr. Ames consults with legal counsel at her state psychological
association and discovers that her state does not have a “duty to
protect” law requiring clinicians to take steps to protect
identified others from harm (see Chapter 7), nor does it impose
criminal penalties on people living with HIV who know their
HIV status and potentially expose others to HIV. In addition,
her state’s mandatory child abuse–reporting laws do not extend
to pregnancy. Her state does not have a prohibition against a
mental health professional revealing a client’s HIV status to a
third party if there is a high risk of transmission to this third
party. HIPAA also permits disclosure of information to protect
against serious harm to others. However, the attorney also
informs her that if she disclosed such information, she might
incur legal liability under a variety of civil laws.
Step 4: Stakeholders.
Dr. Ames consults with medical colleagues regarding the
probability that James will transmit the virus to Angela and the
risks to the fetus and learns that infectivity rates are highly

variable, ranging from 1 per 1,000 to 1 per 3 contacts, that
mother to child transmission is 15% to 30% and occurs mostly
in the last trimester, and that diagnosis and treatment during
pregnancy can reduce perinatal transmission (Centers for
Disease Control and Prevention, 2015). She also speaks to the
prenatal department of the community clinic and finds out that
health care providers there routinely provide pregnant women
with information regarding HIV risk protection and available
HIV testing. To ensure that she is sensitive to the cultural
context from which James’ and Angela’s reactions to her
decision may be embedded, she also consults with staff in the
community outreach department. Some staff express the belief
that the risk of HIV is well-known in the community and that
Angela is responsible for protecting herself. Others believe that
James is violating community standards and that he has
therefore given away his right to confidentiality (see Fisher et
al., 2009). Still others point out that Dr. Ames may lose the
trust of the rest of her group therapy members if she violates
James’ confidentiality (Standard 10.03, Group Therapy).
Through all of these discussions, Dr. Ames is careful not to
reveal the identities of James and Angela (Standard 4.06,
Consultations).
Step 5: Generating alternatives and selecting a course of action.
Dr. Ames begins to contemplate alternative actions. From a
Kantian/deontic perspective, by not disclosing the HIV risk
information to Angela, she would fulfill her confidentiality
commitment to James, on which his autonomous consent to
participate was based. At the same time, Kant’s idea of
humanity as an end in itself might support taking steps to
protect Angela and her fetus from harm. From a utilitarian
perspective, the importance of protecting Angela and her fetus
from a potentially life-threatening health risk must be weighed
against the unknown probability of HIV infection to Angela and
her fetus as well as Angela’s reaction to the disclosure. Dr.
Ames also considers what type of decision would preserve the
trust she has developed with her other group therapy

clients/patients. The advisory board consultation suggested that
there was not a broadly shared common moral perspective that
would suggest a specific communitarian or multicultural
approach to the problem. From a relational ethics perspective,
failing to disclose the information to Angela might perpetuate
the powerlessness and victimization of women. At the same
time, disclosure might undermine Angela’s autonomy if in fact
she is aware of HIV risk factors in general and knows or
suspects James’ HIV positive status.
Dr. Ames decides that she will not at this point disclose James’
HIV status to Angela. She concludes that her promise of
confidentiality to James is explicitly related to his agreement to
participate in treatment, while her sense of obligation to protect
Angela from James’ behavior is not related to Angela’s
agreement to participate in individual therapy. The feedback Dr.
Ames received from community outreach staff suggests that
Angela is most likely aware of the general risks of HIV
transmission among drug users, and some of Angela’s comments
in Dr. Ames’ notes from previous sessions reinforce this
inference. In addition, Dr. Ames’ visit to the clinic indicated
that there are community health services that routinely advise
pregnant women about these risks and provide HIV testing. Dr.
Ames decides that at her next individual session with Angela,
and during subsequent sessions, she will encourage her to visit
the free prenatal clinic for HIV testing, as well as discuss
sexual health, related prenatal risks, and the value of prenatal
care. She will also tell James of her decision not to disclose his
HIV status to Angela at this time, continue to encourage him to
do so, and provide him with written information regarding
prenatal HIV risk and safer sexual practices.
Step 6: Monitoring.
Dr. Ames will monitor and evaluate the effectiveness of her
course of action. During sessions, she will keep apprised of
whether Angela visits the prenatal clinic, including whether
Angela is tested for HIV. She will also monitor whether James
gains the confidence to reveal his HIV status to Angela,

especially as Angela enters her third trimester. If Angela
remains unaware of her risk, Dr. Ames will ask the couple to
come in for a joint session and prepare James in advance for
how the information will be shared. In addition, Dr. Ames will
continue to evaluate whether the unexpected multiple
relationship with James and Angela compromises her ability to
maintain objectivity in her individual and group sessions with
them and seek consultation if necessary. Dr. Ames also reflects
on the adequacy of the criteria she has been using to determine
the composition of therapy groups and begins to develop (a)
more detailed screening procedures for her individual clients
that can identify individuals who may be more prone to
romantic or other types of involvement with group members and
(b) a plan for referring such clients to another group therapist
when appropriate.
Doing Good Well
Ethical decision making in psychology requires flexibility and
sensitivity to the context, role responsibilities, and stakeholder
expectations unique to each work endeavor. At their best,
ethical choices reflect the reciprocal interplay between
psychological activities and interpretation of ethical standards
in which each is continuously informed and transformed by the
other. The specific manner in which the APA Ethics Code
General Principles and Ethical Standards are applied should
reflect a “goodness of fit” between ethical alternatives and the
psychologist’s professional role, work setting, and stakeholder
needs (Fisher, 2002b, 2003c; Fisher & Goodman, 2009; Fisher
& Ragsdale, 2006; Masty & Fisher, 2008). Envisioning the
responsible conduct of psychology as a process that draws on
psychologists’ human responsiveness to those with whom they
work and their awareness of their own boundaries,
competencies, and obligations will sustain a profession that is
both effective and ethical.
Ethics requires self-reflection and the courage to analyze and
challenge one’s values and actions. Ethical practice is ensured
only to the extent that there is a personal commitment

accompanied by ethical awareness and active engagement in the
ongoing construction, evaluation, and modification of ethical
actions. In their commitment to the ongoing identification of
key ethical crossroads and the construction of contextually
sensitive ethical courses of action, psychologists reflect the
highest ideals of the profession and merit the trust of those with
whom they work.
Hot Topic
The Ethical Component of Self-Care
The professional practice of psychology can be rewarding as
well as stressful. Psychological treatment often involves
working with clients/patients who express acute or chronic
suicidality, engage in self-harm, are victims of abuse or assault,
or are coping with the death of loved ones or with their own
chronic or fatal disease. Clinicians treating veterans or others
with posttraumatic stress disorder (PTSD) are regularly
assessing and treating patients struggling with repetitive
aggressive or homicidal episodes that may place the
client/patient, their family, and the treating psychologist in
physical danger (Voss Horrell, Holohan, Didion, & Vance,
2011). Those treating survivors of sexual abuse by family
members or strangers may find their clients’ experiences have a
personal impact on their own worldview and life meaning
(Courtois, 2015).
The Emotional Toll of Professional Practice
The emotional toll and precarious nature of this work makes
psychologists vulnerable to occupational stress, including
emotional exhaustion, depersonalization, and a feeling of lack
of personal accomplishment. These outcomes can in turn lead to
burnout, overcompensating efforts to “save” clients/patients or
participants, boundary violations, and other behaviors that
impair job performance (APA Committee on Colleague
Assistance, 2006; Lee, Lim, Yang, & Lee, 2011; Webb, 2011).
For example, military psychologists with extended deployments
to war zones who practice in life-threatening contexts risk
direct trauma-related distress and vicarious distress working

with traumatized military personnel (W. B. Johnson et al., 2011;
Johnson, Bertschinger, Snell, & Wilson, 2014). Psychologists
working with patients or research participants who graphically
describe child or partner abuse, homelessness and hunger, drug
abuse and violence, or death and dying may also experience
vicarious or secondary trauma, guilt, or a sense of
powerlessness for which there is little institutional support
(Fisher, True, Alexander, & Fried, 2013; Mailloux, 2014;
McGourty, Farrants, Pratt, & Cankovic, 2010; Simmons &
Koester, 2003). Psychologists who have a client/patient die
from suicide, accident, or fatal disease may not recognize or
receive social support for their own grief reactions (Doka,
2008).
Psychologists conducting clinical research requiring strict
adherence to manualized treatment protocols and those working
in schools, military hospitals, or correctional facilities may
experience the painful feelings and psychological
disequilibrium that characterizes moral distress—lack
of professional control to do what they believe is right (Corely,
2002; Fried & Fisher, in press) in response to institutional
constraints on caseload, resources, use of evidence-based
practices (EBPs), up-to-date assessment instruments, or trained
personnel (Maltzman, 2011; O’Brien, 2011; Voss Horrell et al.,
2011). School psychologists working in underpopulated rural
settings may experience stressors associated with isolation when
they feel detached from both the surrounding community and
their professional community (Edwards & Sullivan, 2014). Or in
response to work-related stressors, psychologists may develop
compassion fatigue or begin to process client/patient
experiences on a purely cognitive level, a syndrome W. B.
Johnson et al. (2011) described as “empathy failure.”
“Wounded Healer”
Competent treatment of fatally ill, violent, or suicidal
clients/patients may require extensive patient contact,
behavioral monitoring, interactions with family members, and
significant flexibility in identifying appropriate treatment

strategies. Not surprisingly, many ethical dilemmas for
psychologists working with these patients revolve around
decisions regarding maintaining an appropriate balance between
personal and professional boundaries (e.g., Standards 3.04,
Avoiding Harm; 3.05, Multiple Relationships; 7.07, Sexual
Relationships with Students and Supervisees; and 10.05, Sexual
Intimacies with Current Therapy Clients/Patients).
Working in emotionally charged therapeutic contexts can lead to
work-related exhaustion, a sense of urgency, and worries that
may compromise competent therapeutic decisions (Standard
2.06, Personal Problems and Conflicts). Practitioners who have
little or no preparation for treating posttraumatic phenomena
may overrespond by engaging in rescue behaviors that blur
appropriate professional boundaries or underrespond by
distancing, blaming, or responding aggressively to the client,
thereby causing additional interpersonal damage (Courtois,
2015). On the other hand, such experiences can lead to unique
professional growth. Jackson (2001) introduced the
term wounded healer to describe how the emotional experience
of working with such clients/patients can serve to eventually
enhance psychologists’ therapeutic endeavors. Voss Horrell et
al. (2011) have described similar positive developments in
compassion satisfaction and posttraumatic growth in response to
the challenges of treating veterans with PTSD.
Mindfulness-Based Stress Reduction
Research and clinical scholarship on the potential for and
diminished work competence associated with burnout, social
isolation, compassion fatigue, depression, and vicarious
traumatization among psychologists working with high-risk
populations have led to a widening endorsement of self-care
practices as an essential ethical tool in ensuring competence in
psychological work (APA, 2012f). Discerning when stress
becomes impairment is difficult in the present moment (Barnett,
2008) and thus requires a proactive approach to self-care that
mitigates the effect of stressors on professional competence
(Tamura, 2012).

One such approach is mindfulness-based stress reduction
(MBSR; Kabat-Zinn, 1993) as adapted for the practice of
psychology. MBSR is rapidly becoming a popular approach for
maintaining appropriate competencies under stressful work
conditions. MBSR is a technique for enhancing emotional
competence through attention to present-moment inner
experience without judgment. It is seen as an effective means of
reducing emotional reactions toward and identification with
clients’/patients’ problems that can lead to therapeutic deficits
(Christopher & Maris, 2010; Davis & Hayes, 2011; Shapiro,
Brown, & Biegel, 2007). Several recent studies have
demonstrated positive effects of MBSR training on counseling
skills and therapeutic relationships, including distribution of
self-care educational materials in graduate courses and
modeling and mentoring self-care habits in supervisory
relationships (Christopher, Christopher, Dunnagan, & Schure,
2006; McCollum & Gehart, 2010).
Practical Guidelines for Self-Care
While there are empirical studies on effective approaches such
as MBSR for maintaining and developing the competencies
required, several psychologists have generously shared their
own experiences and hard-earned professional insights on
personal and professional approaches to such challenging cases
(Barnett, Cornish, Goodyear, & Lichtenberg, 2007; Bearse,
McMinn, Seegobin, & Free, 2013; O’Brien, 2011; Tamura,
2012; Webb, 2011).
Specific self-care strategies for competent practice include the
following:
· Minimize risks posed by the social isolation of working in
individualized therapeutic settings through formal (peer
consultation or supervision) and informal (professional
conferences, lunch with peers) activities.
· Schedule activities that are not work related and develop daily
strategies for transitioning from work life to home life.
· Develop healthy habits of eating, sleeping, and exercise.
· Set appropriate boundaries for work-related activities such as

beginning and ending sessions on time and limiting work-
related phone calls or emails to specific times of the day or
early evening.
· Diversify work activities and/or caseload.
· Utilize personal psychotherapy as a means of addressing
psychological distress and enhancing professional competence
through increased self-awareness, self-monitoring, and
emotional competence.
Preparing Psychology Trainees for Work-Related Risks and
Self-Care
Self-care strategies should be included in graduate education
and training and encouraged as lifelong learning techniques
(Bamonti et al., 2014; Barnett & Cooper, 2009). Trainees and
young professionals may be particularly susceptible to stressors
associated with clinical work, especially when programs have
not provided training in self-awareness and self-regulation
techniques to balance self and other interests and because they
lack experience in maintaining emotional competence
(Andersson, King, & Lalande, 2010; Shapiro et al., 2007;
Tamura, 2012). W. B. Johnson et al. (2011) proposed that
psychologists acknowledge the ethical obligation to routinely
assess their colleagues’ performance. This is especially
important in graduate and internship programs in which students
may rely on peer and faculty reactions as measures of their own
competence. Programs should thus strive to create a culture of
community competence that encourages trainees to recognize
themselves as vulnerable to work-related stress and reduced
competence, to recognize personal and professional dysfunction,
and to develop professional self-care habits that support
emotional and professional competence. Developing such a
culture will require a shift from the current reactive self-care
training climate to a proactive and preventive professional one
with a focus on wellness and responsibility to self and others
(Bamonti et al., 2014).
Chapter Cases and Ethics Discussion Questions
A primary care medical center (PCMC) hires an organizational

psychologist to help reduce patient complaints about conflicting
diagnoses and treatment recommendations from different
members of the interdisciplinary team. Discuss the types of
professional virtues or moral dispositions that would be most
important to nurture in a program designed to improve the
performance of treatment staff.
A psychologist is treating a client with explosive anger disorder
who has been in several fights with gang members in his
neighborhood. The client has expressed a desire to purchase a
firearm as protection against the gang. The state has just
enacted a law requiring mental health professionals to file a
report with a firearm background check database if the client
threatens harm to themselves or others. Discuss how different
ethical theories might lead to different decisions about whether
reporting the client is ethically justified. (Readers may wish to
refer to Kangas and Calvert, 2014.)
A graduate teaching assistant (GTA) has repeatedly cancelled
the undergraduate experimental psychology lab section she is
teaching and was late grading students’ final papers. The
professor responsible for the class was aware the GTA was
having trouble keeping up with her graduate coursework and, as
a result, had taken on some of the GTA’s responsibilities during
the semester. The professor is required to complete an end-of-
semester GTA evaluation. A poor evaluation can contribute to
the GTA losing her assistantship. Discuss how the perspectives
and interests of different stakeholders should be considered as
the professor decides what to include on the evaluation form.

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